P582 Serological monitoring for HBV infection and response to vaccination in Greek patients with IBD: a multi-centre study
D. Calogera1, E. Zampeli2, E. Tsironi3, M. Tzouvala4, A. Kostas1, E. Kourkoutas2, S. Siakavellas1, K. Filippakou3, J. Vlachogiannakos1, S. Michopoulos2, G. Papatheodoridis1, G. Bamias*1
1Kapodistrian University of Athens, Laikon Hospital, Academic Department of Gastroenterology, Athens, Greece, 2Alexandra General Hospital, Gastroenterology Department, Athens, Greece, 3Metaxa Memorial Cancer Hospital, Gastroenterology Department, Piraeus, Greece, 4'St. Panteleimon' Nikaia General Hospital, Gastroenterology Department, Piraeus, Greece
Low vaccination rates and sub-optimal responses to vaccination against hepatitis B virus (HBV) have been reported in patients with IBD, raising questions regarding the appropriate management in this setting. We have initiated a multi-centre study to evaluate a) the percentage of Greek IBD patients with protective anti-HBs levels; b) the response to vaccination; and, c) the effect of various patient and disease-related parameters on the efficacy of vaccination.
We reviewed the clinical records of all IBD patients with a regular follow-up at 4 tertiary hospitals at the Athens Metropolitan area. All patients were tested for HBsAg, anti-HBs and anti-HBc antibodies. Patients less than 65-y-old with negative tests for both HBsAg and anti-HBc were managed as follows: a) negative anti-HBs without/unknown history of vaccination: 3-dose vaccination (0, 1, 6 mo) with 20 μg, b) history of vaccination: anti-HBs levels >100iu/l: annual follow-up of anti-HBs levels; anti-HBs 10-100iu/l, 1-3 20 μg doses with anti-HBs measurement after each dose; no anti-HBs, 1-3 40 μg doses with anti-HBs measurement after each dose. Vaccination was considered complete when anti-HBs>100iu/l were detected. In patients with negative anti-HBs levels after 3x20 μg doses, vaccination was repeated with a double dose (40 μg).
We have included 287 IBD patients so far in our study (CD=180, UC=104, IC=3, male=147, age: 42.9 ± 16.0, 16-89). Among 213 patients with recent HBV serology, there were 3 with chronic HBV infection (HBsAg+) and 22 patients with previous exposure to HBV (HBsAg-, anti-HBc+). Protective immunity due to previous vaccination (HBsAg-, anti-HBc-, anti-HBs+>100iu/L) was detected in 23.5% (n=50). Sub-optimal anti-HBs levels were seen in 8.9% (n=19). The majority of tested patients were negative for all three markers (HBsAg, anti-HBc, and anti-HBs), indicating lack of effective vaccination (n=119, 55.8%). If only patients less than 65-y-old were analyzed (n=180), effective immunity was still absent in 54.4%. There was significant association (p<0.001) between age and presence of protective immunity that is probably due to the widespread application of HB vaccination at early ages in the last 2 decades in Greece. Vaccination was commenced in 64 patients so far, with 24 having finished their regimen. Response has been assessed in 10 patients with 6 (60%) achieving sufficient response and 4 requiring further vaccination.
A significant percentage of Greek IBD patients lack protective immunity against HBV. The "classical" vaccination regimen often fails to induce adequate levels of anti-HBs antibodies. Increased awareness, intensified vaccination protocols and frequent testing of response may be required in this population.